Mother and Infant Retention for Health (MIR4Health)

描述（由申请人提供）：消除母婴传播艾滋病毒将需要确定有效、可行、具有成本效益和可扩展的方式， 使感染艾滋病毒的孕妇及其婴儿继续参与预防母婴传播以及艾滋病毒护理和治疗方案，在整个预防母婴传播级联过程中保持无缝连续。我们建议母婴保留健康（MIR 4 Health），创新的实施科学研究，重点是确定一个有效的多组分战略，以改善新发现的艾滋病毒感染孕妇的联系和保留访问母婴保健服务在Nyzana省，肯尼亚。该研究是一项随机试验，旨在比较使用主动患者随访（APFU）的新策略的有效性，以吸引和保留新发现的妊娠艾滋病毒感染妇女及其婴儿，与目前的护理标准（SOC）相比，保留妇女及其产后暴露的婴儿。拟议的APFU包括一套循证干预措施，包括健康教育、提供电话和短信服务预约提醒、主动跟踪患者联系和保留，以及个性化的保留和依从性支持。主要目的是评价APFU + SOC与SOC相比对产后6个月时母婴滞留综合结局的有效性。此外，我们还将检查干预措施对其他关键结果的有效性，包括第二次产前检查的产妇出勤率; CD 4+细胞计数和HIV RNA病毒载量的变化; 6周时艾滋病毒暴露婴儿的聚合酶链反应（PCR）检测;以及妇女和婴儿对处方抗逆转录病毒治疗的依从性。MIR 4 Health的几个创新之处在于，它认识到新发现的感染艾滋病毒的孕妇特别容易在预防母婴传播中受到不良的影响，母亲和儿童都必须得到照顾，以确保最佳的健康结果。采用一种可行、务实的方法，解决已知的障碍，建立在循证干预措施的基础上，如果成功，有可能扩大规模，这有助于肯尼亚努力消除新的儿科感染和保障孕产妇健康。 公共卫生相关性：将感染艾滋病毒的孕妇与预防母婴传播服务联系起来，并让她们继续接受这种服务，对于确保母亲和婴儿都能从改善产妇健康和减少艾滋病毒传染给婴儿的干预措施中受益至关重要。我们提出了一个创新的研究（MIR 4 Health），以评估一个多方面的务实的战略，以连接和保留新发现的艾滋病毒感染的孕妇和他们的婴儿在艾滋病毒护理在整个产前和产后期间在尼扬扎省，肯尼亚。这项研究的结果将推进孕产妇和儿童健康，艾滋病毒的护理，治疗和预防领域，通过展示拟议的战略是否有效，可行和可接受的保障孕产妇健康和减少围产期艾滋病毒传播。

DESCRIPTION (provided by applicant): Elimination of maternal to child transmission of HIV will require identification of effective, feasible, cost- effective and scalable ways to engage and retain HIV-infected pregnant women and their infants in prevention of mother to child transmission (PMTCT) and HIV care and treatment programs in a seamless continuum across the entire PMTCT cascade. We propose Mother Infant Retention for Health (MIR4Health), an innovative implementation science study focused on identifying an effective multicomponent strategy to improve linkage and retention of newly identified HIV infected pregnant women accessing mother child health services in Nyzana Province, Kenya. The study is a randomized trial to compare the effectiveness of a novel strategy using Active Patient Follow-Up (APFU) to engage and retain newly identified pregnant HIV-infected women and their infants in care compared to the current standard of care (SOC) for the retention of the women and their exposed infants postpartum. The proposed APFU includes a package of evidence-based interventions including health education, provision of phone and short message service appointment reminders, active tracking of patients for linkage and retention, and individualized retention and adherence support. The primary aim is to evaluate the effectiveness of APFU plus SOC compared to SOC on the combined outcome of retention of both mother and infant at 6 months postpartum. In addition, we will examine the effectiveness of the intervention on other critical outcomes including maternal attendance at 2nd antenatal visit; changes in CD4+ cell count and HIV RNA viral load; Polymerase Chain Reaction (PCR) testing of HIV-exposed infants at 6 weeks; and adherence by women and infant to prescribed antiretroviral regimens. MIR4Health is distinguished by several innovations including the recognition that the newly identified HIV-infected pregnant woman especially vulnerable to poor retention within PMTCT and that both mother and child must be retained in care to ensure optimal health outcomes. The use of a feasible, pragmatic approach that addresses known barriers, builds on evidence based interventions and is potential to be scaled-up if successful can contribute to Kenya's efforts towards elimination of new pediatric infections and to safeguard maternal health. PUBLIC HEALTH RELEVANCE: Linkage and retention of HIV-infected pregnant women into prevention of mother to child transmission (PMTCT) services is crucial to ensure both mother and infant benefit from interventions that improve maternal health and decrease HIV transmission to infants. We propose an innovative study (MIR4Health) to evaluate a multicomponent pragmatic strategy to link and retain newly identified HIV-infected pregnant women and their infants in HIV care throughout antenatal and postpartum period in Nyanza Province, Kenya. The results of this research will advance the field of maternal and child health, HIV care, treatment, and prevention by demonstrating whether the proposed strategy is effective, feasible and acceptable in safeguarding maternal health and decreasing perinatal HIV transmission.